The Spanish Flu and Canadian Influenza Vaccine Initiatives
Total Page：16
File Type：pdf, Size：1020Kb
DefiningMomentsCanada.ca THE SPANISH FLU AND CANADIAN INFLUENZA VACCINE INITIATIVES Christopher J. Rutty, Ph.D. significant but sometimes overlooked element in the history of the Spanish Flu pandemic of 1918-19 A was the experimental production, distribution and wide use of influenza vaccines. Since the vaccines were based on an erroneous view that influenza was caused by a bacteria (the influenza virus would not be isolated until 1933) such vaccines were ineffective and thus of little importance to the course of the pandemic from a medical or public health perspective. However, the story of the vaccines produced to prevent pandemic influenza, particularly in Canada, reveals much about the application of uncertain knowledge in the face of an unprecedented public health emergency. It also reveals the changing state of Canadian biotechnology capacity at the end of World War I. Connaught Antitoxin Laboratories of the University of Toronto led the most significant initiative to produce an influenza vaccine.1 Connaught’s flu vaccine initiative coincided with a significant production effort by the Ontario Provincial Laboratories, along with various smaller scale and more local efforts, particularly in Kingston and Winnipeg.2 Canadian vaccine efforts were also linked to emergency vaccine preparation in New York City, Boston, and at the Mayo Clinic in Minnesota.3 Influenza vaccines were similarly prepared in other countries in the face of the global pandemic. In 1919, Dr. John G. FitzGerald, Director of Connaught Antitoxin Laboratories, began his summary of Connaught’s influenza vaccine work by observing: “almost coincident with the end of the war a great emergency arose in which the laboratories were provided with an opportunity of doing public service work of a national character.”4 Connaught had been established in May, 1914, as the Antitoxin Laboratory in the Department of Hygiene, 1 Online resources about the history of Connaught Laboratories include: http://connaught.research.utoronto.ca/history/; http:// thelegacyproject.ca 2 J.W.S. McCullough, “The Control of Influenza in Ontario,” Canadian Medical Association Journal 8 (Dec. 1918): 1084-85; available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1585472/; F.T. Cadham, “The Use of a Vaccine in the Recent Epidemic of Influenza,” Canadian Medical Association Journal 9 (June 1919): 519-27; available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1523545/; Guilford B. Reed, “Some Results of Protective Inoculation Against Epidemic Influenza,” Canadian Medical Association Journal 11 (June 1921): 454-56; available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1524167/; see also Andrew Belyea, “Dr. Guilford B. Reed: The Influenza Vaccine That (sort of) Worked,” Museum of Health Care Blog, June 28, 2017, https://museumofhealthcare.wordpress. com/2017/06/28/dr-guilford-b-reed-the-influenza-vaccine-that-sort-of-worked/ 3 T. Leary, “The Use of Influenza Vaccine in the Present Epidemic,” American Journal of Public Health 8 (Oct. 1918): 754-55, 768; available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1362340/ 4 J.G. FitzGerald, “Report of the Director of the Connaught Antitoxin Laboratories, for the year ending June 30, 1919,” in Annual Reports of the Director of the Connaught Laboratories, University of Toronto, 1914-1934, Sanofi Pasteur Canada Archives, Acc. 83-005-03; available at: http://healthheritageresearch.com/clients/docs/Influenza-1918-Vaccine/ConLabs-AnnReptDirector-YrEnd1919-06- 30-Influenza-SPC-83-005-03.pdf © Defining Moments Canada 2018. All rights reserved. DefiningMomentsCanada.ca part of a unique vision by FitzGerald to prepare, develop and distribute -- as a pubic service -- essential biological public health products. Initially, Connaught provided diphtheria antitoxin and Pasteur Rabies Treatment to provincial health departments, for free use. Any proceeds would support research and public health education.5 The onset of World War I triggered the expansion of the Labs, especially in response to a shortage of tetanus antitoxin in the Canadian and British military. With trench warfare exposing wounded soldiers to tetanus spores in the soil, leading to debilitating and deadly infections, tetanus antitoxin could be life- saving. Albert E. Gooderham, of Gooderham & Worts Distillery, facilitated the Labs’ expansion on a farm property at what today is Sanofi Pasteur Canada’s Connaught Campus, on Steeles Avenue West, just east of Dufferin Street in Toronto. Gooderham was a philanthropist and also a member of the University of Toronto Board of Governors and chairman of the Ontario Red Cross. He would formally open the Connaught Antitoxin Laboratories & University Farm on October 25, 1917. The facility was named after the Duke of Connaught, Canada’s Governor General during most of the war. A year later, just as the influenza pandemic reached Toronto, Connaught was shipping its largest ever order of tetanus antitoxin, 16,000 doses (out of a total of some 250,000 doses shipped since 1915) to the Canadian Expeditionary Forces.6 Although the Labs’ facilities were quite modest, its staff had become accustomed to responding to challenges during the war years, mostly under the leadership of Dr. Robert D. Defries. He was Associate Director of the Labs, but worked as Acting Director while FitzGerald served in the Royal Army Medical Corps in France. Since the Labs’ establishment, FitzGerald and Defries had built close connections with several U.S. laboratories, particularly at the New York City Department of Health. Thus, soon after influenza first hit in North America during August and September 1918, Defries was aware of efforts in New York and Boston to prepare an influenza vaccine.7 When the last pandemic struck in 1892, German physician Richard Pfeiffer had isolated a bacterium from the lungs and sputum of influenza patients. Pfeiffer considered B. influenzae to be the cause, but in the absence of another pandemic there was minimal influenza research conducted until 1918. When influenza swept through in New York City and Boston, doctors immediately looked for the “Pfeiffer’s bacterium” in cases of the disease, with the idea of preparing a vaccine. We now know that B. influenzae 5 Christopher J. Rutty, “Personality, Politics and Canadian Public Health: The Origins of Connaught Medical Research Laboratories, University of Toronto, 1888-1917,” in E.A. Heaman, Alison Li and Shelly McKellar (eds.) Figuring the Social: Essays in Honour of Michael Bliss (University of Toronto Press, 2008), p. 273-303; available at: http://healthheritageresearch.com/Rutty-ConnughtOrigin- BlissEssays.pdf 6 Robert D. Defries, The First Forty Years, 1914-1955: Connaught Medical Research Laboratories, University of Toronto (University of Toronto Press, 1968), p. 24. 7 Defries, First Forty Years, “Chapter 7: The Emergency of Epidemic Influenza, 1918-1919,” p. 49-40; available at:http:// healthheritageresearch.com/clients/docs/Influenza-1918-Vaccine/DefriesRD-FirstFortyYears-Ch7-Influenza1918-p49-50.pdf © Defining Moments Canada 2018. All rights reserved. 2 DefiningMomentsCanada.ca (known today as Haemophilus influenzae) is associated with influenza, but is not its cause.8 The first newspaper reports of an influenza vaccine appeared in theNew York Times on October 2, 1918, which noted that “as far as health authorities know, [this] will be the first time that a vaccine has been employed to prevent influenza.” The “new vaccine would be considered revolutionary to laymen, but to physicians it would not be unexpected, as it is the application of an old idea to a new disease.”9 The vaccine was prepared from influenza bacilli that was killed by exposure to heat and then suspended in a salt solution. It was first tried on volunteer lab workers and then distributed in small quantities to physicians. By October 21, newspapers were reporting on influenza vaccines prepared in Philadelphia, Boston, Winnipeg and, in Toronto, by the Connaught Laboratories.10 By October 21, Connaught’s influenza vaccine, prepared from 18 strains provided from New York City and Boston labs, was already being distributed. Seven thousand doses had been shipped -- 3,000 to army authorities and the remainder to Ontario hospitals. Connaught’s vaccine was supplemented by a supply prepared by the Ontario Provincial Board of Health Laboratories. News reports on October 22 noted that more than 10,000 doses had been sent to hospitals and municipal medical officers of health throughout Ontario. In addition, a small supply of vaccine was prepared at Toronto General Hospital by Dr. H.K. Detweiler of the Department of Pathology and offered to its staff. The Provincial Board of Health would soon have enough vaccine on hand to enable its use among the general public.11 Elsewhere in Canada, including in Montreal and the Maritimes, some vaccine was sourced from the Massachusetts State Board of Health. Meanwhile, in Winnipeg, there was an initiative by the Manitoba Provincial Laboratory to prepare a “mixed-strain” vaccine based on a method developed by Dr. E.C. Rosenow at the Mayo Clinic in Rochester, Minnesota. This vaccine also included strains of pneumococcus and streptococcus bacteria believed responsible for the deadly pneumonic complications of influenza. Using local strains and strains provided by Rosenow, the Manitoba Board of Health prepared some 600,000 doses for physicians’ use in Winnipeg and elsewhere in Western Canada; 100,000 doses were also prepared at Winnipeg General Hospital and the city operated a series of free vaccination clinics.12 In Kingston, Dr. Guilford B. Reed, of Queen’s University, also produced a mixed-strain influenza vaccine 8 J.K. Taubenberger, J.V. Hultin, D.M. Morens, “Discovery and Characterization of the 1918 Pandemic Influenza Virus in Historical Context,” Antivir Ther 12 (4, Pt. B) (2007): 581-91; available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2391305/ 9 “Tells of Vaccine to Stop Influenza,” New York Times, Oct. 2, 1918, p. 10; available at: http://healthheritageresearch.com/clients/docs/ Influenza-1918-Vaccine/NewYorkTimes-1918-10-02-p10-clip.jpg 10 Philadelphia Inquirer, Oct. 19, 1918, p.